Welcome to Romero Clinic! We do the most Botox and Radiesse on Long Island!

DR. WILLIAM H.E. ROMERO
103 Majestic Drive, Dix Hills, NY 11746
(631) 858-0500
HOMEBOTOXJUVEDERMRADIESSEBELOTEROVOLUMADERMAPENLASER & BBLVIPEELVEINS

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NEW PATIENT FORMS

Thank you for choosing Romero Clinic! Prior to your initial consultation, you may want to print and fill out the following forms to lessen your time in the waiting room.

*Please use only BLACK ink so that your forms will scan properly into our filing system.

 

NEW PATIENT INFORMATION FORM
For ALL Patients

AESTHETIC MEDICAL HISTORY
For New Patients Coming For Cosmetic Treatments

 

 


Thank you and we look forward to seeing you soon!

 

AWARD-WINNING
SERVICE


Romero Clinic
Best of LI Botox Practice
Long Island Press 2012


Dr. Romero
Patients' Choice Award
Vitals.com 2014

 
Dr. Romero
Most Compassionate Doctor Award
Vitals.com 2013

 

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Romero Clinic 2012